MP36-16: Virtual Imaging 3D Anatomical Modeling Can Facilitate Laparoscopic or Robotic Donor Nephrectomy in Patients With Complex Renal Anatomy That Were Precluded From Donation Based on Computed Tomography Angiography or Magnetic Resonance Imaging

Ravi Munver*, Jennifer Kuo, Michael Degen, Hackensack, NJ

Introduction: In the setting of complex renal anatomy certain patients may be excluded as renal donors. We describe the use of IRIS™ (Intuitive Surgical, Inc), a virtual imaging segmented three-dimensional (3D) anatomical modeling software, for preoperative planning and intraoperative navigation to facilitate laparoscopic or robotic donor nephrectomy. This technology produces a 3D model of kidney anatomy that is created from thin slice contrast CT scan images. The virtual model is delivered to an iOS device and can also be displayed via a hardwire connection from an iOS device to the robotic surgical console.

Methods: Since June 2020, a total of 63 consecutive living renal donors underwent computed tomography angiography (CTA) as part of the preoperative evaluation. Virtual 3D modeling was performed for all patients based on the CTA images, highlighting the renal anatomy, vasculature, collecting system, and ureter. The CTA and 3D models were reviewed by the living donor and recipient teams for patients with complex renal anatomy in order to evaluate their candidacy for renal donation.

Results: Four (6.3%) of the 63 patients were not considered as acceptable candidates for renal donation based on CTA or magnetic resonance imaging findings of renal abnormalities, including 3 renal arteries bilaterally (n=1), 3 right renal arteries and 2 left renal arteries with a circumaortic left renal vein (n=1), 2 left renal arteries with an early bifurcation of the main artery (n=1), and a right 3 cm perirenal mass in the area of the renal hilum (n=1). Following review of the 3D anatomical reconstructed images, all patients were cleared to undergo donor nephrectomy based on the additional information that was provided from the virtual models. In the patient with the perihilar mass, the 3D imaging delineated the mass as arising from the renal parenchyma. This patient underwent robotic donor nephrectomy with ex-vivo excision of the mass (pathology: lipid-poor renal angiomyolipoma), with successful subsequent renal transplantation. All 63 patients underwent uneventful laparoscopic or robotic donor nephrectomy.

Conclusions: Virtual 3D anatomical modeling with IRIS™ allows surgeons to perform donor nephrectomy in patients that may otherwise be excluded from renal donation. This technology offers preoperative interpretation of renal anatomy, provides confidence in the setting of complex vasculature, and facilitates planned procedural completion.

Source of Funding: None